Specialist Haematology —
Training activity: 16

Details

Select and interpret testing for the diagnostic techniques used for the investigation of mature lymphoid neoplasms to include:

• Chronic lymphocytic leukaemia
• Monoclonal B lymphocytosis
• Plasma cell myeloma

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What are the intended outcomes of the training activity?

• How will you focus your attention on selecting techniques, complying with national/international guidelines, and performing quality assurance specifically for CLL, MBL, and Plasma cell myeloma?
• In what ways will exploring the curriculum considerations—such as the WHO classification, aetiology, and current concepts on molecular mechanisms—help guide your preparation?
• What specific knowledge do you need regarding the role of flow cytometry, serum protein electrophoresis (SPE), and bone marrow assessment before you begin the investigation?
• How will this activity help you define success in providing a diagnostic report that supports both the initial classification and the long-term monitoring of treatment in the correct clinical context?

What do you anticipate you will learn from the experience?

• What specific insights do you hope to gain regarding the diagnostic pathways and the differential diagnosis between related entities, such as CLL and MBL?
• Based on what you already know, how do you anticipate this activity will deepen your understanding of prognostic markers (e.g. TP53 status or IGHV mutational status) and monitoring strategies?
• How do you expect this experience to improve your ability to comply with BSH, WHO, and NICE guidelines when navigating the diagnostic algorithms for mature lymphoid neoplasms?
• In what ways will this activity prepare you for the high-level analytical and interpretive responsibilities required to ensure reliable results through the performance of IQC and EQA?

What actions will you take in preparation for the experience?

• How will you discuss the diagnostic protocols and workflow for lymphoid malignancies with your Training Officer to ensure you have a clear understanding of departmental expectations?
• What possible challenges have you identified—such as distinguishing monoclonal B-cell populations from reactive states or interpreting complex protein electrophoresis patterns—and how do you plan to handle them?
• Which specific guidelines (e.g. BSH guidelines for the diagnosis of CLL or management of Plasma cell myeloma) will you gather beforehand to ensure your interpretations are evidence-based?
• How do you feel about embarking on this investigation? Does acknowledging feelings of curiosity or the weight of responsibility regarding long-term patient monitoring help you focus on the technical precision required?

In action

What are you doing?

• Based on the initial clinical presentation and laboratory findings (e.g. lymphocytosis or a paraprotein), which diagnostic tests are you choosing to investigate these neoplasms—such as morphology, flow cytometry, or serum electrophoresis?
• How are you ensuring your choice of investigations and initial interpretations comply with national and international guidelines (e.g. WHO classification, BSH, or NICE) for mature lymphoid cancers?
• What decisions are you making regarding prioritising tests to distinguish between a benign MBL and a case of CLL requiring treatment?
• What aspects of your practice feel intuitive—such as spotting characteristic ‘smudge cells’ on a film—and what requires more conscious effort, such as the precise interpretation of complex flow cytometry gating for plasma cells?

How are you progressing with the activity?

• As you obtain results from various techniques (e.g. bone marrow biopsy alongside serum protein electrophoresis), how are you integrating this information in real-time to differentiate between CLL and plasma cell myeloma?
• How are you performing quality assurance and control tasks as the activity unfolds, such as verifying that IQC and EQA for the electrophoresis or flow platforms are within acceptable limits before you proceed?
• Are you noticing any overlapping features causing diagnostic challenges, and what are you learning from these specific cases as they unfold?
• How does this investigation connect to your existing knowledge of the aetiology and pathogenesis of mature lymphoid malignancies?

How are you adapting to the situation?

• If you encounter overlapping or conflicting features—such as a borderline lymphocyte count or an unusual immunophenotype—what alternative approaches or additional markers (e.g. cytogenetics for TP53) are you considering?
• Are you working within your defined scope of practice, and at what point do you recognise the need for support or guidance from a senior colleague or the multidisciplinary team (MDT)?
• How are you troubleshooting technical issues with the testing platforms (e.g. electrophoresis reagent flags) as they occur to ensure the investigation remains on track?
• How are you adapting your strategy to ensure the final report provides the necessary information for the clinical team to monitor treatment effectively?

On action

What did you notice?

• What were the key clinical and laboratory findings—such as persistent lymphocytosis, the presence of a paraprotein, or specific symptoms like bone pain—that raised suspicion for CLL, MBL, or plasma cell myeloma?
• How did you select the specific investigative techniques, including peripheral blood and bone marrow morphology, immunophenotyping (flow cytometry), cytogenetics, and molecular studies?
• For suspected myeloma, what were the results of serum and urine electrophoresis and bone marrow biopsy with plasma cell quantification?
• In terms of Quality Assurance, did you verify that the internal quality control (IQC) and external quality assurance (EQA) for the electrophoresis and flow cytometry platforms were within acceptable limits before the data was integrated?
• How did you integrate these multi-parameter results to form a definitive interpretation, and were there any discordant findings between the morphology and the immunophenotype?

What did you learn from the activity?

• What are the specific diagnostic criteria for CLL, MBL, and plasma cell myeloma according to current WHO classifications and IMWG criteria?
• How did you use the laboratory findings to differentiate between these entities, such as the threshold for clonal B-cells used to distinguish MBL from CLL?
• In what ways did you comply with national and international guidelines (e.g. BSH or NICE) to ensure the investigation was performed in the correct clinical context?
• How do these findings—such as cytogenetic abnormalities or mutational status—inform the prognosis, risk stratification, and monitoring of treatment?
• How did your reflection-in-action (the decisions you made as the case progressed) influence the efficiency of the diagnostic pathway?
• How does this experience relate to the high-level analytical and interpretive requirements for post-programme practice as a Clinical Scientist?

What will you take from the experience moving forward?

• How has this activity enhanced your ability to select the most appropriate investigations for patients with suspected mature lymphoid neoplasms?
• Which key resources and guidelines have you identified as essential for navigating the evolving diagnostic criteria for these disorders?
• How will you improve your skills in the integrated interpretation of results, ensuring that protein chemistry, morphology, and flow cytometry are synthesised into a clear clinical report?
• What specific ‘next steps’ will you take, such as attending a multidisciplinary team (MDT) meeting to observe how laboratory results impact the management of patients with myeloma or CLL?
• How will you apply your learning regarding quality assurance to ensure that the long-term monitoring of these patients remains robust and reliable?

Beyond action

Have you revisited the experiences?

• Since completing this training activity, have you investigated other cases of CLL, MBL, or plasma cell myeloma, perhaps encountering different stages of disease or varied clinical presentations?
• How has your understanding of the diagnostic criteria and the role of specific findings—such as the immunophenotype in CLL or the paraprotein in myeloma—evolved since you wrote your initial reflect-on-action notes?
• Can you recall Multidisciplinary Team (MDT) discussions where the laboratory’s role in the diagnosis, staging, or monitoring of these neoplasms was a focus?
• As part of a holistic review of the Specialist Haematology (S-HT-S2) module, how does this investigation connect to your learning in other training activities, such as the investigation of acute leukaemia?
• Have you engaged in professional storytelling with peers or senior colleagues, and has this mutual exchange changed your view of these complex diagnostic pathways?
• Have you reviewed updated national and international guidelines (e.g. WHO classification, BSH, or NICE guidelines) to see how they have informed your recent practice?

How have these experiences impacted upon your current practice?

• How has this training activity enhanced your ability to select and interpret the correct laboratory tests to diagnose and differentiate between these mature lymphoid neoplasms in the correct clinical context?
• In what ways are you now more consistently integrating clinical, morphological, immunophenotypic, and molecular findings to comply with WHO and national guidelines?
• How has your performance of quality assurance and control tasks matured, ensuring that IQC and EQA for platforms like flow cytometry and electrophoresis are robust before results are reported?
• How has this cumulative learning supported your preparation for observed ‘in-person’ assessments, such as a DOPS for ‘performing the initial morphological investigation for a chronic leukaemia’?
• Are the analytical and interpretative skills developed here—such as the critical evaluation of multi-parameter datasets—being transferred to other areas of your work?

How might these experiences contribute towards your future practice?

• How will your experience in diagnosing and monitoring these conditions prepare you for managing often indolent but progressive lymphoid disorders and staying abreast of therapeutic advancements?
• Will your ability to accurately interpret diagnostic and monitoring data contribute to more effective patient management and risk stratification?
• What clear actions for continued development have you identified, such as implementing new diagnostic or prognostic markers in mature lymphoid neoplasms?
• How might this experience support your progression towards a specialist role in haematological oncology, where you may lead on method validation or quality improvement initiatives?

Relevant learning outcomes

#	Outcome
# 3	Outcome Select and interpret a range of laboratory and molecular testing techniques to diagnose and monitor treatment of haematological malignancy in the correct clinical context.
# 4	Outcome Interpret and comply with national and international guidelines on the diagnosis and management of haematological cancer.
# 7	Outcome Perform quality assurance and control tasks across the range of investigations.